Edmarlon Girotto

Adesão ao tratamento farmacológico e não farmacológico e fatores associados na atenção primária da hipertensão arterial

A cross-sectional study was conducted with 385 hypertensive patients between 20 and 79 years of age in a family health unit in Londrina, State of Parana, Brazil, to determine the adherence to pharmacological and non pharmacological treatment for arterial hypertension in primary healthcare and identify associated factors. The adherence to pharmacological treatment was 59%. Regular physical activity was reported by 68 (17.7%) hypertensive patients and 266 (69.1%) mentioned dietary changes. In the multiple regression analysis, adherence to drug treatment was associated with: increased age (50 to 79), consulting with a physician at least once a year, no regular alcohol consumption and previous myocardial infarction. Hypertensive males, with education up to 4th grade and above, who had at least one consultation per year, with diabetes or no history of high cholesterol, were more adherent to physical activity. Dietary changes were associated with education below the 4th grade and consulting with a physician at least once a year. These results show variable levels of adherence to treatment and demonstrate the importance of comprehensive actions in the care for hypertensive patients.

Psychoactive Substance Use by Truck Drivers: A Systematic Review

The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1–91.0%); amphetamines (0.2–82.5%), marijuana (0.2–29.9%), cocaine (0.1–8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.

Use of simulated patients to evaluate combined oral contraceptive dispensing practices of community pharmacists.

Background Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. Objective To evaluate the COC dispensing practices of CPs in a developing country. Method A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients’ medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Results Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., “do you smoke?” (n = 2) and “what is your age?” (n = 1). None of the CPs measured the patient’s blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. Conclusion The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure.

Use of Illicit Drugs by Truck Drivers Arriving at Paranaguá Port Terminal, Brazil

Objective: The purpose of this study was to estimate the prevalence of recent use of illicit drugs among truck drivers who had parked their vehicles at the terminal port in Paranaguá City at Paraná State, southern Brazil. Methods: This cross-sectional study was part of a larger research project conducted among drivers at a regional Brazilian port. Data on professional characteristics, involvement in road traffic injuries, sleep, and use of alcohol and illicit drugs were collected using a questionnaire. Urine samples were collected and analyzed for amphetamines, cocaine, and cannabis using gas chromatography with mass spectrometric detection. Results: Sixty-two drivers were included in the study. Toxicological analyses showed that 8.1 percent (95% confidence interval [CI], 2.7–17.8%) of the urine samples were positive for drugs (4.8% for cocaine, 1.6% for amphetamine, and 1.6% for both); 8.1 percent reported drug use during the preceding 30 days in the questionnaire and only one tested positive for the drug in the urine sample. No sample was positive for cannabinoids. In total, at least 14.5 percent (95% CI, 6.9–25.8%) had used illicit drugs during the preceding 30 days based on self-reports and urine testing. Drivers who reported involvement in traffic injuries the year before more often tested positive for drugs in biological samples (P <.05). Conclusions: This research provides preliminary evidence that the use of illicit stimulants was common among professional truck drivers transporting grain loads. Thus, actions are needed to reduce drug use among truck drivers in order to prevent drug-related road traffic injuries.

Professional experience and traffic accidents/near-miss accidents among truck drivers.

AIM To investigate the relationship between the time working as a truck driver and the report of involvement in traffic accidents or near-miss accidents. METHODS A cross-sectional study was performed with truck drivers transporting products from the Brazilian grain harvest to the Port of Paranaguá, Paraná, Brazil. The drivers were interviewed regarding sociodemographic characteristics, working conditions, behavior in traffic and involvement in accidents or near-miss accidents in the previous 12 months. Subsequently, the participants answered a self-applied questionnaire on substance use. The time of professional experience as drivers was categorized in tertiles. Statistical analyses were performed through the construction of models adjusted by multinomial regression to assess the relationship between the length of experience as a truck driver and the involvement in accidents or near-miss accidents. RESULTS This study included 665 male drivers with an average age of 42.2 (±11.1) years. Among them, 7.2% and 41.7% of the drivers reported involvement in accidents and near-miss accidents, respectively. In fully adjusted analysis, the 3rd tertile of professional experience (>22years) was shown to be inversely associated with involvement in accidents (odds ratio [OR] 0.29; 95% confidence interval [CI] 0.16-0.52) and near-miss accidents (OR 0.17; 95% CI 0.05-0.53). The 2nd tertile of professional experience (11-22 years) was inversely associated with involvement in accidents (OR 0.63; 95% CI 0.40-0.98). CONCLUSIONS An evident relationship was observed between longer professional experience and a reduction in reporting involvement in accidents and near-miss accidents, regardless of age, substance use, working conditions and behavior in traffic.

Knowledge and conduct of pharmacists for dispensing of drugs in community pharmacies: a cross-sectional study

O objetivo do presente estudo foi avaliar o conhecimento de farmaceuticos e verificar suas condutas em relacao a dispensacao de medicamentos. Trata-se de um estudo transversal realizado em quatro municipios das regioes sul e sudeste do Brasil, que sao referencia no cenario nacional de saude e concentram 73,6% da atividade economica nacional. Farmaceuticos que trabalham em farmacias comunitarias foram convidados a responder um questionario elaborado pelos autores do presente estudo e validado. Os principais desfechos medidos foram o conhecimento farmaceutico, avaliado segundo o numero de acertos em um questionario elaborado pelos pesquisadores, e a conduta dos profissionais durante a dispensacao de medicamentos. Os dados foram coletados de setembro a dezembro de 2012 e as informacoes obtidas foram tabuladas em duplicata por dois pesquisadores para posterior analise. 486 farmacias comunitarias foram visitadas, mas apenas 112 profissionais participaram do estudo. Entre os participantes, 78,6% (n = 88) nao tinham conhecimento satisfatorio para realizar a dispensacao de medicamentos, apesar de este mesmo numero de farmaceuticos terem afirmado participar de congressos e cursos apos a graduacao. As principais fontes de informacao sobre medicamentos utilizados pelos participantes possuem um baixo nivel de evidencia cientifica. A realizacao de tarefas nao diretamente relacionadas a profissao reduz o tempo disponivel para o atendimento aos usuarios de medicamentos. Alem disso, a venda indiscriminada de antibioticos e a comercializacao de produtos alheios a saude descaracterizam o papel do farmaceutico na farmacia comunitaria. Existem lacunas no conhecimento dos profissionais, o que limita a realizacao satisfatoria de dispensacao de medicamentos. Alem disso, o excesso de atribuicoes e a conduta profissional inadequada comprometem a promocao do uso racional de medicamentos.

Determining factors for neonatal mortality in a city in the Southern Region of Brazil

This is an ecological quantitative study to identify risk factors that determined neonatal death between the years of 2000 to 2009 in Londrina, Paraná, using data from Birth Certificates, Death Certificates and Infant Death Investigation Forms. The variables maternal age, years of education, family income, occupation, marital status, type of delivery, and number of prenatal appointments were not associated to neonatal death. To the contrary, birth weight, gestational age, Apgar score at 1 and 5 minutes, and place of birth were identified as statistically significant variables. More than 73.0% of newborns died within early neonatal period. The predominant basic cause of death was perinatal problems (77.7%), 72.6% of which were preventable, and the majority of which could be reduced with adequate control over pregnancy/birth. These results highlight the need for investments in prevention of premature delivery by improvement of health care in prenatal and birth periods, in an equanimous, accessible and comprehensive manner in all levels of maternal and child health care.

A Systematic Review of the Effects of Continuing Education Programs on Providing Clinical Community Pharmacy Services

Objective. To summarize the effects of media methods used in continuing education (CE) programs on providing clinical community pharmacy services and the methods used to evaluate the effectiveness of these programs. Methods. A systematic review was performed using Medline, SciELO, and Scopus databases. The timeline of the search was 1990 to 2013. Searches were conducted in English, Portuguese, and Spanish. Results. Nineteen articles of 3990 were included. Fourteen studies used only one media method, and the live method (n=11) was the most frequent (alone or in combination). Only two studies found that the CE program was ineffective or partially effective; these studies used only the live method. Most studies used nonrobust, nonvalidated, and nonstandardized methods to measure effectiveness. The majority of studies focused on the effect of the CE program on modifying the knowledge and skills of the pharmacists. One study assessed the CE program’s benefits to patients or clients. Conclusion. No evidence was obtained regarding which media methods are the most effective. Robust and validated methods, as well as assessment standardization, are required to clearly determine whether a particular media method is effective.

Working conditions and illicit psychoactive substance use among truck drivers in Brazil.

Background The aim of this study was to identify the role that working conditions play in predicting the consumption of illicit psychoactive substances (IPS) among truck drivers. Methods This cross-sectional study was conducted with truck drivers who transport grains to Paranaguá Port, PR, Brazil. The truck drivers were interviewed, and they completed a self-administered questionnaire regarding their sociodemographics, lifestyles, working conditions, and consumption of IPS over the past 30 days. The statistical analysis included logistic regression models progressively adjusted for sociodemographic and lifestyle variables. Results A total of 670 male drivers with a mean age of 41.9 (±11.1) years were assessed. The prevalence of IPS consumption over the past 30 days was 10.9% (n=73). The drugs used primarily consisted of amphetamines (n=61). After adjusting for working characteristics, sociodemographic and lifestyle variables, the following working conditions were associated with the consumption of IPS: driving mostly at night (OR=3.91; 95% CI 1.75 to 8.74), driving while tired (OR=2.26; 95% CI 1.31 to 3.89), and earning a higher monthly income (OR=2.08; 95% CI 1.16 to 3.72). Drivers who were 39 years old or younger (OR=2.11; 95% CI 1.05 to 4.25) and not living with a partner (OR=2.22; 95% CI 1.17 to 4.22) were also more likely to consume IPS. Conclusions Driving mostly at night, being tired, and earning more increase the use of IPS among truck drivers, regardless of other working characteristics, sociodemographic, and lifestyle variables.

Associação entre assistência pré-natal e mortes neonatais, 2000-2009, Londrina-PR

The study aimed to analyze the prenatal care for mothers of infants who died in the neonatal period, in Londrina-PR, through a quantitative retrospective cohort study, between 2000 and 2009. Almost all women held the prenatal care (91.4 %), with 55.1 % up to six consultations. In ten years, the low number of visits (≤ 6) predominated. There was a statistically significant relationship between the number of prenatal visits and maternal sociodemographic variables (p < 0.004) and characteristics of the labor and the newborn (p < 0.001). The surgical delivery was predominant among women with ≥ 7 queries (71.3 %). Among women with ≤ 6 prenatal visits, 65.9 % of births occurred before 32 weeks of gestation, 79.8 % of the newborns had Apgar scores ≤ 6 at 1 minute and 51.7 % weight ≤ 1000 grams. Most deaths occurred in the early neonatal period (72.6 %). We highlight the necessity of qualitative and integrative prenatal care in this city, considering beyond biological conditions but also maternal socio-economic conditions in order to reduce neonatal deaths.